[Treatment of humeral pseudarthroses by open reduction and internal fixation]

Abstract

Objectives: The effectiveness of open reduction and plate fixation combined with autogenous bone grafting was assessed in the treatment of humeral diaphysis pseudarthrosis.

Methods: Twenty-four patients (16 men, 8 women; mean age 44 years; range 28 to 64 years) were operated on for humeral pseudarthrosis. Of these, 16 patients and eight patients had had previous surgical and conservative treatments, respectively. Surgery was performed after a mean of 10.8 months (range 7 to 21 months) following the initial treatments. Preoperatively, none of the patients had infected nonunion, a bone defect greater than 4 cm, and radial nerve injury. Treatment included open reduction and plate fixation combined with autogenous bone grafting. The plate was secured with at least four screws (8 cortices) both proximally and distally. The mean follow-up was 40 months (range 28 to 60 months). The range of motion of the shoulder and elbow was evaluated according to the criteria by Rommens et al. Functional evaluations were made according to the criteria by Stewart and Hundley.

Results: Union was achieved in all the patients after a mean of 19 weeks (range 14 to 26 weeks). Shoulder range of motion was excellent in all the patients. Elbow range of motion was excellent in 22 patients and moderate in two patients. Functional results were excellent in 20 patients and good in four patients. Deep infection, nonunion, malunion, implant failure, or permanent nerve injury did not occur in any of the patients. Two patients had transient radial nerve palsy.

Conclusion: Treatment with open reduction and plate fixation combined with autogenous bone grafting is a safe and effective option in humeral pseudarthroses, particularly in cases without infection, bony defect, and deformity requiring correction.